Uncontrolled Hypertension in a Child with Phaeochromocytoma: Management Challenges In A Resource-Limited Setting

Abstract

Background  Hypertension in childhood which is usually uncommon and secondary to renal or other diseases, poses significant challenges to the health system in resource-limited settings due to lack of
access to diagnostic and management facilities.
Methods The case records of an affected 11 year old male and the review of literature were utilised to highlight the diagnostic and management challenges in this case.
Results An 11 year old male was diagnosed with hypertension secondary to a pheochromocytoma following presentation with severe hypertension (220/180mmHg) associated with frontal headache, easy
fatigueability and deterioration in vision. Urinalysis, microscopy and culture, Renal and thyroid function tests, lipid profile, full blood count and  abdominal ultrasound and Computerised Tomographic scanning
were normal. Electrocardiogram and echocardiography showed features of hypertensive heart disease. Urinary vanylylmandelic acid and homovanillic acid assays suggested phaeochromocytoma. No  anti-hypertensive combination controlled the blood pressure. He was referred to India where abdominal magnetic resonance imaging revealed a left sided retroperitoneal, adrenal, para- aortic tumour which, on
resection, was confirmed as phaeochromocytoma. Post-operatively all clinical features resolved and he became well.
Conclusion The challenges posed by delayed presentation, lack of access to adequate facilities and  skilled health manpower required for the management of challenging health situations in resource-limited settings have been highlighted. Running title Pheochromocytoma; Uncontrolled hypertension in Children; management challenges; resource-limited settings.

Keywords Hypertension, Phaeochromocytoma, Childhood, Resource-limited settings.